Federal healthcare fraud is a serious offense that carries severe legal consequences, including hefty fines, exclusion from federal healthcare programs, and prison time. As federal authorities ramp up enforcement efforts, particularly through task forces like the Health Care Fraud Strike Force, individuals and entities involved in the healthcare industry must understand how fraud is defined, prosecuted, and defended as a Tampa, FL drug defense lawyer who has been rated by Super Lawyers can further explain.
What Is Federal Healthcare Fraud?
Healthcare fraud typically involves knowingly submitting false or misleading information to a federal healthcare program — such as Medicare or Medicaid — to receive unauthorized benefits or payments. These cases are prosecuted under a variety of federal statutes, including:
- The False Claims Act (FCA)
- The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)
- The Health Care Fraud Statute (18 U.S.C. § 1347)
- The Stark Law (physician self-referral law)
Violations can involve physicians, pharmacists, billing staff, home health agencies, nursing homes, durable medical equipment suppliers, and even patients.
Common Examples Of Healthcare Fraud
Some of the most common types of federal healthcare fraud include:
- Billing For Services Not Rendered: Submitting claims for procedures or visits that never took place.
- Upcoding: Charging for a more expensive service than what was actually provided.
- Unbundling: Billing separately for procedures that should be billed together at a reduced cost.
- Kickbacks: Accepting or offering payments or gifts in exchange for patient referrals or business.
- Medically Unnecessary Services: Performing or billing for services that aren’t medically justified.
Penalties For Healthcare Fraud
The penalties of a healthcare fraud conviction can be devastating. They may include:
- Up to 10 years in prison per count (20 years if the fraud results in serious bodily injury)
- Civil penalties of up to $11,000 per false claim, plus three times the amount of damages
- Exclusion from Medicare, Medicaid, and other federal healthcare programs
- Damage to professional licenses and reputations
How Is Healthcare Fraud Investigated?
Federal healthcare fraud investigations are often launched after whistleblower reports, audits, or data mining reveal irregularities. Agencies involved in these investigations include:
- The Department of Justice (DOJ)
- The Office of Inspector General (OIG)
- The Centers for Medicare and Medicaid Services (CMS)
- The Federal Bureau of Investigation (FBI)
Investigations can span years and often involve subpoenas, raids, and interviews with staff and patients. Even if you’re only a target or a witness, your rights and your livelihood may be at risk.
Legal Defenses Against Healthcare Fraud
Defending against healthcare fraud charges requires a detailed understanding of both the facts and the law. Common defenses include:
- Lack Of Intent: Federal prosecutors must prove that the defendant knowingly and willfully committed fraud.
- Clerical Or Billing Errors: Honest mistakes or poor record-keeping are not crimes.
- Compliance With Industry Standards: Demonstrating that your billing or practices were consistent with accepted norms.
- Insufficient Evidence: Challenging the government’s ability to prove its case beyond a reasonable doubt.
In many cases, early intervention by a skilled federal criminal defense attorney can lead to reduced charges, civil settlements, or even the avoidance of criminal prosecution altogether.
Contact A Federal Criminal Defense Attorney Today
If you or your business is under investigation for healthcare fraud — or if you’ve already been charged — it’s essential to act quickly. Federal prosecutors are aggressive, and the penalties are too serious to handle alone. There is also a statute of limitations on these cases you should be aware of.
Contact Stechschulte Nell today for a confidential consultation with one of our lawyers who has been rated 10.0 by Avvo. We have extensive experience in federal healthcare fraud cases and will fight to protect your rights, your reputation, and your future.
